What is unique about EMDR supervision?
Before I continue, let me say that this column is not just for EMDR supervisors but will, hopefully, be relevant to all EMDR therapists who are in receipt of supervision (which should be all of us!) to help us to get more out of the supervision we receive and become more informed recipients of clinical supervision.
I am delighted that our editor, Beverly, has invited me to resume my regular column on EMDR supervision. My first two columns can be found in Issues 3-4 and 4-1 of ETQ and these looked at giving feedback to one’s supervisor, defining supervision, discussing why supervision is necessary and how it differs from training or therapy.
Since those two columns were written a year ago, I have submitted my book on EMDR supervision to the publishers and it will hopefully be on the shelves by the end of this year. I have also started running consultant’s trainings in addition to those run by Sandi Richman and I was also honoured to present a keynote presentation on the topic of EMDR supervision last year at the Germany EMDR association conference in Cologne.
So, what do I have for you in today’s column? This time I will be looking at what is unique about EMDR supervision as compared to clinical supervision generally. I obviously needed to do this in order to justify writing my book as there are plenty of excellent books out there regarding clinical supervision as well as some good training courses.
Firstly, I wondered whether there is actually a specific EMDR model of supervision. Other therapies have supervision models which reflect their model of therapy. So, for example, CBT supervision will include agenda setting, Socratic questioning and homework which are, of course, all elements of a CBT therapy session (Corrie & Lane, 2015; Milne, 2018). By contrast, psychodynamic supervision is more supervisee-centred and gives greater attention to the supervisee’s own dynamics (Ekstein & Wallerstein, 1958). So, to what extent should EMDR supervision draw upon our own Adaptive Information Processing (AIP) model (Shapiro, 2007)? At first sight the AIP model does not immediately lend itself to a clear way of doing supervision. One of the things that initially attracted me to EMDR was that, in my opinion, it draws on the ’best bits’” of several older therapeutic modalities. The AIP model itself shares with psychodynamic psychotherapy and trauma-focused CBT, for example, the idea that we need to go back to the experience of the original trauma in order to process it. From mindfulness approaches comes the instruction to “just notice”, from psychodynamic therapy comes free association, from body therapies comes the link with the felt sense in the body, and from CBT comes the structured aspects of the Assessment Phase. So, it is my contention that, in a similar way, our model of supervision should take the ’best bits’ from the ways in which these other therapies are supervised (Hawkins & McMahon, 2020).
One way in which EMDR supervision can be unique is that it involves helping the supervisee to integrate EMDR with their existing way of working because one cannot train in EMDR without first being trained and experienced in another therapeutic modality. Let us illustrate this with what Naomi Fisher, EMDR Consultant, said to a group of her supervisees who were all new to EMDR therapy:
When people start learning EMDR they can feel really de-skilled. It feels like, “Errh! This new thing I’ve got to learn how to do.” But actually, you keep all of your other skills and EMDR, you can integrate it and all the systemic thinking and everything, it’s all still completely relevant. You’re still highly skilled professionals who are learning a new skill which will integrate and then you’ll be, like, amazing!
People often think, “oh, I don’t know what to do now”, and it’s almost like they forget everything else and they think, “I’ve got to do this new thing. I’ve got to follow the protocol.”
As Naomi demonstrated above, it is about integrating something new with what you already know. At an online workshop regarding EMDR supervision in 2020, Derek Farrell referred to the concept of “pattern matching” in which trainees attempt to understand new concepts regarding EMDR by comparing them with what they already understand about their existing way of conceptualising their work (Farrell, 2020). Come to think of it, this is, in fact, the AIP process in action where we attempt to assimilate new experiences into our pre-existing understanding of ourselves and the world.
Many of us, as supervisees, may have felt irritated by our supervisor asking for our ’Supervision Question’ (SQ) before allowing us to tell them about our client. My supervisees tell me that they love to hear my stories to illustrate the points I wish to make, particularly the ones in which I have got things wrong! So here is one such story: I once told my supervisor that my SQ was “how can I overcome my client’s resistance?” As soon as I had asked this question, I knew where I was going wrong. My supervisor smiled sweetly, and we were able to quickly move on. Providing the SQ can be hard work for the supervisee. But formulating this question in itself can be transformative and already puts the therapist on the road to understanding where they may be going wrong even before they have said any more about their client.
So why do we pay particular attention to the SQ in EMDR supervision? Here is an analogy: In EMDR therapy we often struggle to help our client find their Negative Cognition (NC). This process will sometimes be quite lengthy, but it can be time well spent and the actual process of identifying the NC itself can be a critical part of the therapy. On occasions, the client’s discovery of their NC is a crucial turning point in the therapy before the actual Desensitisation Phase has even started. And so it is with the SQ. The SQ provides the focus that I need as a supervisor to really help my supervisee to get what they want out of the session. It also helps me to know when to interrupt if I think that the information that they are providing is irrelevant to the SQ.
How often do we hear politicians being interviewed and trying to wriggle out of a sticky situation by telling their interviewer that they are asking the ’wrong question’? By contrast, for an EMDR supervisor, this may actually be a legitimate thing to say. Knowing what the SQ is often alerts the supervisor to the fact that the supervisee may, in fact, be asking the ’wrong’ question. The SQ may, for example, be about how they should change their approach with their client because the processing is not reducing the SUDS scores. What they might really need to be asking, however, is a question regarding formulation and an understanding as to what is actually going on with their client which might lead them to a different target memory.
Another thing that we impress upon trainee EMDR consultants is to ’teach from the theory’. As a supervisor our instinct may often be to rescue our supervisee by telling them exactly what to do with a particular client. It reminds me of that old proverb: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”. By going back to some basic principles regarding EMDR, grounded in the AIP model, our supervisees will learn something, not just about how to work with this particular client, but how they may assist many other clients that they may encounter in the future.
And finally, EMDR supervision can differ from supervision in other modalities because of the way in which it is tied into the basic EMDR training which includes an element of supervision and is also linked with our accreditation system. As with any therapy, there needs to be a process of contracting when the supervisor and therapist meet for the first time. At this point it needs to be established that they will be working towards practitioner accreditation and that this will involve an element of evaluation in addition to education and enabling (more of this in a later column). This evaluation will include the requirement to observe the therapist’s work by video or in vivo. It should be accepted that contracting (rather like the History Taking phase of EMDR therapy) may be an ongoing process which one may need to return to at a later stage after several supervision sessions.
In future columns I will say more about accreditation and the evaluative component of EMDR supervision. But let’s finish with another story, this time about my daughter, Emily, who is a farm vet. When she was training at Bristol University, she was required to carry out a procedure on a horse and was observed by one of her tutors to check whether she was carrying out the procedure according to the approved protocol. The horse had to be restrained whilst Emily injected it in the leg. There were several things that Emily was required to do before the injection. However, the horse was becoming increasingly agitated and Emily knew that, if she did not inject quickly, the horse would become out of control and she would be unable to safely administer the injection. She therefore skipped one part of the procedure and jabbed the needle into the horse and injected it safely.
When the procedure had been completed, Emily’s tutor asked her if she could state what the correct procedure was. Emily correctly outlined the procedure. Her tutor asked her therefore why she had omitted one part of the procedure. Emily explained that if she had done it according to the book, there was a distinct risk that the horse’s agitation would have made it impossible for her to give the injection. The tutor told her that she was absolutely right and awarded her full marks for the assessment.
The moral of this story, if it hasn’t become obvious already, is that it is important to know what the protocol is. There are times when you need to deviate from the protocol, but you should do so knowingly and be able to give a rational justification for doing so.
Corrie, S., & Lane, D. (2015). CBT supervision. London: Sage.
Ekstein, R., & Wallerstein, R. S. (1958). The teaching and learning of psychotherapy. New York: Basic Books.
Farrell, D. (2020). Advanced clinical supervision and consultation skills in enhancing competency in EMDR therapy. EMDR Lebanon Association.
Hawkins, P., & McMahon, A. (2020). Supervision in the helping professions (5th ed.). London: Open University Press.